REGISTRATION

Name_____________________________________

__________________________________________
Address              __Check if this is a new address

___________________________________________
City State Zip

___________________________________________
Home Phone Work Phone

___________________________________________
E-mail

Childcare will not be provided.

REGISTRATION FEE: $120/person                 

TOTAL ENCLOSED: $_____________

Make checks payable to: Cornerstone Church

Registrations are non-refundable.

Please bill my:         __Visa          __ Mastercard

Card #__________________________________

Expiration Date___________________________

Signature _______________________________

__ Check if you are a first-time attendee to a Cornerstone event.

Mail to: Cornerstone Church c/o Conference
269 W. Harbeck Rd.
Grants Pass, OR. 97527
or Fax to: 541-479-6875 Phone: 541-479-7799 Email: cschurch@chatlink.com